Healthcare Provider Details

I. General information

NPI: 1194834713
Provider Name (Legal Business Name): PROFESSIONAL OPTICIANS PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 MOORE DR
LEXINGTON KY
40503
US

IV. Provider business mailing address

165 MOORE DR
LEXINGTON KY
40503
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-5409
  • Fax: 859-276-3491
Mailing address:
  • Phone: 859-278-5409
  • Fax: 859-276-3491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number0366
License Number StateKY

VIII. Authorized Official

Name: MR. JOHN C HOLTMANN
Title or Position: PRESIDENT
Credential: ABO
Phone: 859-278-5409